becker orthopedic central fabrication
Transcription
becker orthopedic central fabrication
3495 ChapterTabs 2/19/05 1:29 PM Page 2 SECTION II Central Fabrication BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 CENTRAL FABRICATION HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES 3495 Sec2 Tabs 2/19/05 3:34 PM Page 1 HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) SECTION II Central Fabrication HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.1.1 3495 Sec2 Tabs 2/19/05 3:34 PM Page 2 BECKER ORTHOPEDIC CENTRAL FABRICATION HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) Otto K. Becker, Sr. began offering central fabrication services to the orthotic profession in 1938. He established rigorous quality control procedures, timely delivery schedules, and opened lines of communication to the orthotist. These principles continue today, and as the market changes, our central fabrication services will continue to grow with the needs of the O & P professional. Central fabrication combines quality with quick delivery to compete in the changing managed care market. Central fabrication fixes your costs, which allows practitioners to see patients, develop referrals and cut overhead. Please refer to the chart at the bottom of this page for our delivery schedules. CENTRAL FABRICATION SERVICES PROVIDE: • Highly trained technicians with direct access to the largest orthotic componentry selection available • Quick turnaround time and open lines of communication • Guaranteed customer satisfaction 2.1.2 BeckerOrthopedic.com DELIVERY SCHEDULE HKAFO RGO KAFO AFO Cranial Orthoses Upper Extremity Phone: Fax: 5 Days 5 to 7 Days 2 to 5 Days 1 to 3 Days 1 to 3 Days 1 to 3 Days 800-521-2192 800-923-2537 3495 Sec2.1 HKAFO 2/19/05 3:48 PM Page 1 MODEL 227 BILATERAL HKAFO Model 227 is a bilateral metal and leather hip-knee-ankle-foot orthosis which can provide a variety of functions depending upon the type of hip, knee, and ankle joints chosen. Please pick from the following options: NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. • Shown with optional knee pads and growth adjustments Order No. 227 228 Description Bilateral HKAFO Unilateral HKAFO HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) • Any Becker Hip, Knee, Ankle Joint and Stirrup. Please be sure to specify model and size. • Black, Brown, Beige, or White Leather • Hook and Loop, or Buckle Closures • Thermo-Clad™, High Buff, or Sand Blasted Finish of Uprights Leg Both Left or Right NOTE: Please send tracing, or negative cast impression, shoes to be attached, and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.1.3 3495 Sec2.1 HKAFO 2/19/05 3:48 PM Page 2 HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KAFO/HKAFO ORTHOMETRY FORM: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Wt: ______ MEASUREMENTS: Inches Centimeters Ankle Knee Varus Valgus Varum Valgum Flexible Rigid Flexible Rigid Degrees: __________________ Degrees: __________________ Toe Out Toe In Hyperextended Medial Plane Knee Flexion Contracture Lateral Plane Degrees: __________________ Degrees: __________________ Heel Height: _______________ 2.1.4 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.1 HKAFO 2/19/05 3:48 PM Page 3 KAFO/HKAFO ORTHOMETRY FORM CONTINUED: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ MATERIAL: Thermoplastic Metal and Leather TYPE: KAFO HKAFO Thermoplastic Options Metal and Leather Options Plastic (select one from each column) Type Thickness Location Flares Polypropylene 1/8" Anterior Proximal Copolymer 5/32" Posterior Medial Polyethylene 3/16" Lateral 1/4" Leather (select one from each column) Color Closure T-Strap Knee Pad Condyle Pad Black Hook & Medial 3-Buckle Round* Beige Loop Lateral 4-Buckle Pear Smoked Elk Leather None 5-Buckle * Cannot Brown Strap & use with White Buckle 1002 KJT Correct cast to: _____________________ Do not correct cast Liner (select one from each column) Type Thickness Location Aliplast 1/8" Thigh Posterior Med-Density Pelite 5/32" Anterior Foot Plate Heavy-Density Pelite 3/16" Plantar Surface 1/4" Other _________________ Ankle Joints (select type) Dorsiflexion Assist Dorsiflexion Plus Assist Slim Line Double Action Original Double Action Standard Action Size: A (Adult) B (Youth) Stirrup (select type) Solid Solid Wide Flange Split UCBL Other __________ C (Child) Range of Motion Ankle Joints (select type) Tamarack Tamarack Dorsi Assist Tamarack Variable Assist™ Tamarack Clevisphere™ Oklahoma (Polypro) Oklahoma (Heavy Duty Nylon) Size: A (Adult) B (Youth) 655 755 Gillette Gillette Heavy Duty Gillette Dorsi Assist Camber Axis Hinge® Other __________________ __________________________ C (Child) Posterior Stops 795 Other ________________ None Plantarflexion _______________ Dorsiflexion _______________ Hip Joint Options Hip Joints (select one from each column) Please see catalog section 3 for model numbers Type Free Motion Ring Lock Adjustable R.O.M. Model Number: ________________ Knee Joint Options Specials Knee Joints (select one from each column) Growth Adjustments Please see catalog section 4 for model numbers Type Material Size A (Adult) B (Youth) C (Child) I (Infant) Laminated Thigh Size Upright Finish AK Anterior Cuff Free Motion E-Knee (9001) Aluminum 1/4"x 3/4" (Select Type) BK Posterior Cuff Ring Lock LR-9002 (9002) Stainless Steel 3/16"x 3/4" High Buff Lever Lock (Bail) G-Knee (9003) Titanium* 1/4"x 5/8" Ratchet Lock Carbon Fiber 3/16"x 5/8" Model Number: _________________ (9003 only) * Not available on Lateral Both Thermoclad 3/16"x 1/2" Black 1/8"x 1/2" White Blue all Joints Contoured: Medial Bead Blast None Additional add-ons Ball Catch Thigh Lacer Calf Lacer HD Lever Release Kit SS Footplate (please provide cast) Tongue: AK BK Other:___________________________ HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) LEG: Left Right Bilateral Wt: ______ Additional Instructions: BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.1.5 3495 Sec2.1 HKAFO 2/19/05 3:48 PM Page 4 HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) MODELS 328 & 329 ISOMETRIC AND BIOMETRIC RECIPROCATING GAIT ORTHOSES (RGO) Models 328 and 329 are custom made Reciprocating Gait Orthoses that are designed to assist pediatric and adult paraplegics achieve functional walking. Both models utilize low friction bearings that permit smooth articulation. The dual pivot Biometric System, model 329, has a wider range of adjustment and therefore should be considered when hip flexion contractures are present. Both models 328 and 329 use an easy to operate Thumb Post to lock and unlock the hip joints. NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. ISO-METRIC RGO Order No. 328 328-A 328-K Description Iso-Metric RGO Pelvic Section Only Iso-Metric RGO with AFOs Iso-Metric RGO with KAFOs BIO-METRIC RGO Order No. 329 329-A 329-K Description Bio-Metric RGO Pelvic Section Only Bio-Metric RGO with AFOs Bio-Metric RGO with KAFOs NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. 2.1.6 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.1 HKAFO 2/19/05 3:48 PM Page 5 RGO ORTHOMETRY FORM Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Wt: ______ 328 Iso-Metric Pelvic section only 329 Bio-Metric Pelvic section only 328-K Iso-Metric RGO with KAFOs 329-K Bio-Metric RGO with KAFOs 328-A Iso-Metric with AFOs 329-A Bio-Metric with AFOs Plastic (Kydex): Ivory Liner: White Chest Straps: White Black Beige Gray Blue Beige Rainbow Pink Black ISO-Metric System Options: Padded Strap Abdominal Strap Extra Liner Vacuum Formed TLSO Please Complete Entire Orthometry Form For Best Fit MEASUREMENTS: Inches Centimeters Millimeters CIRCUMFERENCES M-L DIAMETERS BIO-Metric System LENGTHS PROXIMAL ASPECT XYPHOID PROCESS PROXIMAL ASPECT to WAIST WAIST HIP JOINT CENTER WAIST to HIP JOINT CENTER Lordosis ISCHIAL TUBEROSITY KNEE AXIS FIBULAR NECK HJC to Gluteus Maximus ANKLE AXIS HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) Pelvic Section Additional Instructions: BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.1.7 3495 Sec2 Tabs 2/19/05 3:35 PM Page 3 SECTION II Central Fabrication KNEE-ANKLE-FOOT ORTHOSES (KAFO) HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.2.1 3495 Sec2 Tabs 2/19/05 3:35 PM Page 4 MODEL 225 METAL AND LEATHER KAFO Model 225 is a metal and leather knee-ankle-foot orthosis. All bands are padded and covered with leather. Please pick from the following options: KNEE-ANKLE-FOOT ORTHOSES (KAFO) • Any Becker Knee, Ankle Joint and Stirrup. Please be sure to specify model and size. • Black, Brown, Beige, or White Leather • Hook and Loop, or Buckle Closures • Thermo-Clad™, High Buff, or Sand Blasted Finish of Uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Order No. 225-L 225-R 225-P Description Metal and Leather KAFO Metal and Leather KAFO Metal and Leather KAFO Side Left Right Pair MODELS 230 & 235 GENU VALGUM/VARUM KAFOS Models 230 and 235 are single upright, metal and leather, knee-ankle-foot orthoses. Both may be fabricated with or without a knee joint. Below knee growth adjustments are standard. Please pick from the following options: • Any Becker Knee, Ankle Joint and Stirrup. Please be sure to specify model and size. • Black, Brown, Beige, or White Leather • Hook and Loop, or Buckle Closures • Thermo-Clad™, High Buff, or Sand Blasted Finish of Uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. GENU VALGUM KAFO Order No. 230-L 230-R 230-P Description Genu Valgum KAFO Genu Valgum KAFO Genu Valgum KAFO Side Left Right Pair GENU VARUM KAFO Order No. 235-L 235-R 235-P Description Genu Varum KAFO Genu Varum KAFO Genu Varum KAFO Side Left Right Pair NOTE: Please send tracings, or negative cast impression, shoes to be attached, and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.2.2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.2 KAFO 2/19/05 3:47 PM Page 1 MODEL 327 PLASTIC KAFO WITH ARTICULATING ANKLE Model 327 consists of a plastic thigh section attached to a pair of knee joints and a plastic AFO with an articulating ankle. A soft liner may be added upon request. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness • Thermo-Clad™, High Buff, or Sand Blasted Finish of Uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. PLASTIC KAFO WITH SOLID ANKLE Order No. Description 325-L Plastic KAFO with Solid Ankle 325-R Plastic KAFO with Solid Ankle 325-P Plastic KAFO with Solid Ankle Side Left Right Pair PLASTIC KAFO WITH ARTICULATING ANKLE Order No. Description 327-L Plastic KAFO with Articulating Ankle 327-R Plastic KAFO with Articulating Ankle 327-P Plastic KAFO with Articulating Ankle Side Left Right Pair KNEE-ANKLE-FOOT ORTHOSES (KAFO) • Any Becker Knee, Ankle Joint, and Motion Control Limiter. Please be sure to specify model and size. NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.2.3 3495 Sec2.2 KAFO 2/19/05 3:47 PM Page 2 MODEL 332 MONODOS® KAFO Model 332 is a knee-ankle-foot-orthosis designed for the management of spasticity and joint contracture, often associated with cerebral palsy, stroke and spinal cord injury. The design utilizes our model 1900-A Monodos® Joint which features a one-way clutch and allows rotation in one direction, but blocks all rotation in the opposite direction until released. The Monodos® is a cost-effective alternative to serial casting. Please pick from the following options: • Monodos® Knee Joint Upright Material (Aluminum or Stainless Steel) KNEE-ANKLE-FOOT ORTHOSES (KAFO) • Plastic Type, Color (Natural or Black only) and Thickness • Thermo-Clad™, High Buff, or Sand Blasted Finish of Uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. US Patent 5,328,446 One-way motion only Simple release mechanism • The Monodos ® KAFO is not intended for weight bearing applications • For more details on our Monodos ® Knee joint, please see page 4.1.23. Order No. 332-L 332-R 332-P Description Monodos® KAFO Monodos® KAFO Monodos® KAFO Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. If you are looking for a positioning orthosis, you may want to consider incorporating our Variloc® joint into your design. Please see page 4.1.22 for details. 2.2.4 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.2 KAFO 2/19/05 3:47 PM Page 3 KAFO/HKAFO ORTHOMETRY FORM: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Wt: ______ Ankle Knee KNEE-ANKLE-FOOT ORTHOSES (KAFO) MEASUREMENTS: Inches Centimeters Varus Valgus Varum Valgum Flexible Rigid Flexible Rigid Degrees: __________________ Degrees: __________________ Toe Out Toe In Hyperextended Medial Plane Knee Flexion Contracture Lateral Plane Degrees: __________________ Degrees: __________________ Heel Height: _______________ BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.2.5 3495 Sec2.2 KAFO 2/19/05 3:47 PM Page 4 KNEE-ANKLE-FOOT ORTHOSES (KAFO) KAFO/HKAFO ORTHOMETRY FORM CONTINUED: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ LEG: Left Right Bilateral MATERIAL: Thermoplastic Metal and Leather Wt: ______ TYPE: KAFO HKAFO Thermoplastic Options Metal and Leather Options Plastic (select one from each column) Type Thickness Location Flares Polypropylene 1/8" Anterior Proximal Copolymer 5/32" Posterior Medial Polyethylene 3/16" Lateral 1/4" Leather (select one from each column) Color Closure T-Strap Knee Pad Condyle Pad Black Hook & Medial 3-Buckle Round* Beige Loop Lateral 4-Buckle Pear Smoked Elk Leather None 5-Buckle * Cannot Brown Strap & use with White Buckle 1002 KJT Correct cast to: _____________________ Do not correct cast Liner (select one from each column) Type Thickness Location Aliplast 1/8" Thigh Posterior Med-Density Pelite 5/32" Anterior Foot Plate Heavy-Density Pelite 3/16" Plantar Surface 1/4" Other _________________ Ankle Joints (select type) Dorsiflexion Assist Dorsiflexion Plus Assist Slim Line Double Action Original Double Action Standard Action Size: A (Adult) B (Youth) Stirrup (select type) Solid Solid Wide Flange Split UCBL Other __________ C (Child) Range of Motion Ankle Joints (select type) Tamarack Tamarack Dorsi Assist Tamarack Variable Assist™ Tamarack Clevisphere™ Oklahoma (Polypro) Oklahoma (Heavy Duty Nylon) Size: A (Adult) B (Youth) 655 755 Gillette Gillette Heavy Duty Gillette Dorsi Assist Camber Axis Hinge® Other __________________ __________________________ C (Child) Posterior Stops 795 Other ________________ None Plantarflexion _______________ Dorsiflexion _______________ Hip Joint Options Hip Joints (select one from each column) Please see catalog section 3 for model numbers Type Free Motion Ring Lock Adjustable R.O.M. Model Number: ________________ Knee Joint Options Specials Knee Joints (select one from each column) Growth Adjustments Please see catalog section 4 for model numbers Type Material Size A (Adult) B (Youth) C (Child) I (Infant) Laminated Thigh Size Upright Finish AK Anterior Cuff Free Motion E-Knee (9001) Aluminum 1/4"x 3/4" (Select Type) BK Posterior Cuff Ring Lock LR-9002 (9002) Stainless Steel 3/16"x 3/4" High Buff Lever Lock (Bail) G-Knee (9003) Titanium* 1/4"x 5/8" Ratchet Lock Carbon Fiber 3/16"x 5/8" Model Number: _________________ (9003 only) * Not available on Lateral Both Thermoclad 3/16"x 1/2" Black 1/8"x 1/2" White Blue all Joints Contoured: Medial Bead Blast None Additional add-ons Ball Catch Thigh Lacer Calf Lacer HD Lever Release Kit SS Footplate (please provide cast) Tongue: AK BK Other:___________________________ Additional Instructions: 2.2.6 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2 Tabs 2/19/05 3:35 PM Page 5 SECTION II Central Fabrication BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 9000 SERIES KNEE-ANKLEFOOT ORTHOSES (9000 KAFO) HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES 2.3.1 3495 Sec2 Tabs 2/19/05 3:35 PM Page 6 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) MODEL 318 G-KNEE KAFO The G-Knee KAFO, model 318, is intended for individuals with quadriceps weakness. A gas spring, housed in the lateral G-Knee joint, assists knee extension while allowing passive flexion of the knee during the swing phase of gait. The G-Knee offers a manual locking feature and can be equipped with a 50, 75, 100, or 150 Newton gas shock and your choice of stainless steel, or carbon fiber upright. Note: Model 318 is supplied with a ring lock medial joint and ball catch. Please pick from the following options: • Gas Shock Extension Assist available in 50N, 75N (Standard), 100N or 150N to meet individual requirements • Choice of Stainless Steel or Carbon Fiber on G-Knee distal upright • Plastic Type, Color (Natural or Black only) and Thickness • Thermo-CladTM, High-Buff, or Sand Blasted finish of uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options CONTRAINDICATIONS: • Patient has Below Normal Hip Strength • Patient Weight over 190 lbs • Non-Correctable Knee Valgus Greater than 15° • Knee Center to Top of Thigh Section Must be Greater than 230mm • The Contralateral Limb Must be Stable During Free Walking • For more details on our G-Knee joint, please see page 4.3.5. Order No. 318-L 318-R 318-P Description G-Knee KAFO G-Knee KAFO G-Knee KAFO Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. 2.3.2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 1 MODEL 319 LOAD RESPONSE KAFO • Upright material (aluminum, stainless steel, or titanium) • Plastic Type, Color (Natural or Black only) and Thickness • Thermo-CladTM, High-Buff, or Sand Blasted finish of uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Model 319 shown with optional Heavy Duty Lever Release System. • For more details on our LR-9002 Knee joint, please see page 4.3.4. Order No. 319-L 319-R 319-P Description Load Response KAFO Load Response KAFO Load Response KAFO Side Left Right Pair 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) Model 319, is a knee-ankle-foot orthosis that is configured with our LR-9002 knee joints. Load Response knee joints have a preloaded spiral torsional spring and permit 18˚ of stance phase knee flexion. Designed for individuals with severe quadriceps weakness the KAFO provides shock absorption during early stance phase. This system also works very well with our Heavy Duty Lever Release System (see page 2.6.5 for information on our Lever Release Systems). Please pick from the following options: NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.3.3 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 2 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) MODEL 320 E-KNEE KAFO Model 320 is a foot force activated, electromechanical, stance control knee-ankle-foot orthosis that swings freely during swing phase and locks automatically at any angle during weight bearing. The E-Knee will lock regardless of uneven terrain or slope and does not limit KAFO design options. Certification in a Becker E-Knee Course is required to purchase this product. Contact our customer service department for more information. Please pick from the following options: • Upright material (aluminum, stainless steel, or titanium) • Plastic Type, Color (Natural or Black only) and Thickness • Thermo-CladTM, High-Buff, or Sand Blasted finish of uprights NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. CONTRAINDICATIONS: • Any Spasticy in the Hip, Knee, or Ankle Musculature • Patient Weight over 220 lbs • Fixed Varus or Valgus Deformity at the Knee in Excess of 15˚ • Knee Hyperextension Not Controlled by the Orthosis Model 320 comes complete with charger. • For more details on our E-Knee joint, please see pages 4.3.2 and 4.3.3. Order No. 320-L 320-R 320-P Description E-Knee KAFO E-Knee KAFO E-Knee KAFO Size Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. 2.3.4 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 3 KAFO/HKAFO ORTHOMETRY FORM: Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Wt: ______ MEASUREMENTS: Inches Centimeters Ankle Knee Varus Valgus Varum Valgum Flexible Rigid Flexible Rigid Degrees: __________________ Degrees: __________________ Toe Out Toe In Hyperextended Medial Plane Knee Flexion Contracture Lateral Plane Degrees: __________________ Degrees: __________________ 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) Today’s Date: _____________________________________________ Heel Height: _______________ BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.3.5 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 4 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KAFO/HKAFO ORTHOMETRY FORM CONTINUED: 2.3.6 Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ LEG: Left Right Bilateral MATERIAL: Thermoplastic Metal and Leather Wt: ______ TYPE: KAFO HKAFO Thermoplastic Options Metal and Leather Options Plastic (select one from each column) Type Thickness Location Flares Polypropylene 1/8" Anterior Proximal Copolymer 5/32" Posterior Medial Polyethylene 3/16" Lateral 1/4" Leather (select one from each column) Color Closure T-Strap Knee Pad Condyle Pad Black Hook & Medial 3-Buckle Round* Beige Loop Lateral 4-Buckle Pear Smoked Elk Leather None 5-Buckle * Cannot Brown Strap & use with White Buckle 1002 KJT Correct cast to: _____________________ Do not correct cast Liner (select one from each column) Type Thickness Location Aliplast 1/8" Thigh Posterior Med-Density Pelite 5/32" Anterior Foot Plate Heavy-Density Pelite 3/16" Plantar Surface 1/4" Other _________________ Ankle Joints (select type) Dorsiflexion Assist Dorsiflexion Plus Assist Slim Line Double Action Original Double Action Standard Action Size: A (Adult) B (Youth) Stirrup (select type) Solid Solid Wide Flange Split UCBL Other __________ C (Child) Range of Motion Ankle Joints (select type) Tamarack Tamarack Dorsi Assist Tamarack Variable Assist™ Tamarack Clevisphere™ Oklahoma (Polypro) Oklahoma (Heavy Duty Nylon) Size: A (Adult) B (Youth) 655 755 Gillette Gillette Heavy Duty Gillette Dorsi Assist Camber Axis Hinge® Other __________________ __________________________ C (Child) Posterior Stops 795 Other ________________ None Plantarflexion _______________ Dorsiflexion _______________ Hip Joint Options Hip Joints (select one from each column) Please see catalog section 3 for model numbers Type Free Motion Ring Lock Adjustable R.O.M. Model Number: ________________ Knee Joint Options Specials Knee Joints (select one from each column) Growth Adjustments Please see catalog section 4 for model numbers Type Material Size A (Adult) B (Youth) C (Child) I (Infant) Laminated Thigh Size Upright Finish AK Anterior Cuff Free Motion E-Knee (9001) Aluminum 1/4"x 3/4" (Select Type) BK Posterior Cuff Ring Lock LR-9002 (9002) Stainless Steel 3/16"x 3/4" High Buff Lever Lock (Bail) G-Knee (9003) Titanium* 1/4"x 5/8" Ratchet Lock Carbon Fiber 3/16"x 5/8" Model Number: _________________ (9003 only) * Not available on Lateral Both Thermoclad 3/16"x 1/2" Black 1/8"x 1/2" White Blue all Joints Contoured: Medial Bead Blast None Additional add-ons Ball Catch Thigh Lacer Calf Lacer HD Lever Release Kit SS Footplate (please provide cast) Tongue: AK BK Other:___________________________ Additional Instructions: BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 5 MODEL 9004 UTX® KAFO The UTX® is also available as a non-stance control KAFO model, “Stabil”, that locks and unlocks by control of the user. Other models of the UTX® are also available including an “FS” (frontal stability) model to control genu valgum. All UTX® models can be equipped with a medial ankle joint to provide additional control in the coronal and transverse planes. CLINICAL INDICATIONS: • Quadriceps weakness as a result of Poliomyelitis, Multiple Sclerosis, CVA, Femoral Nerve and Incomplete Spinal Cord Injuries • Genu Recurvatum. Use posterior tibial shell for maximum control • Successful users will typically have hip extensor strength (Power 3) and passive ankle dorsiflexion CONTRAINDICATIONS FOR UTX® SWING AND FS MODELS: • Any Spasticity in Hip, Knee or Ankle Musculature • Valgus/Varus Instability at the Knee of More than 10˚ • Patient Weight Over 265 lbs • Substantial Leg Length Discrepancy where the Affected Side is Shorter • Passive Ankle ROM Less than 5˚ of Dorsiflexion UTX® SWING UTX® FS (Frontal Stability) FEATURES: • Manual Unlocking Option • Easy Adjustment of Dorsiflexion and Strirrup Upright Angle FEATURES: • Manual Unlocking Option • Controls Genu Valgum • Easy Adjustment of Dorsiflexion and Stirrup Upright Angle UTX® SWING AND STABIL MODELS Order No. Description 9004-S-80 UTX® Swing 80 9004-S-120 UTX® Swing 120 9004-STABIL-80 UTX® Stabil 80 9004-STABIL-120 UTX® Stabil 120 UTX® FS (FRONTAL STABILITY) AND STABIL FS MODELS Order No. Description 9004-FS-100 UTX® Frontal Stability 100 UTX® Stabil Frontal 9004-STABIL-FS-100 Stabiltiy 100 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) The UTX®, model 9004, was designed and developed by Dr. Nils van Leerdam, of Ambroise Holland bv. It is a lightweight, less than two pounds, knee-ankle-foot orthosis that stabilizes the knee during the stance phase of gait but enables knee flexion during swing phase. At the end of swing phase, as the knee reaches full extension, a ratchet engages to stabilize the knee. A cable runs inside the distal side member from the ankle joint to the knee joint. At the end of stance phase, as the ankle dorsiflexes, this cable linkage causes the knee joint to unlock and destabilize the knee. NOTE: Please send tracing, or negative cast impression and completed UTX® orthometry forms with all necessary measurements. UTX® orthometry forms can be found on pages 2.3.9 through 2.3.10. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.3.7 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 6 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) MODEL 9004 THERMOPLASTIC UTX® KAFO The UTX® is also available as a thermoplastic KAFO. Available in all Swing, Stabil, and Frontal Stability models (please see page 2.3.7 for additional information). FEATURES: • Manual Unlocking Option • Easy Adjustment of Dorsiflexion and Strirrup Upright Angle • Thermoplastic UTX option affords enhanced control of the foot ankle complex • Key feature of the Thermoplastic UTX is its intimate total contact fit and resultant potential to afford increased control of the limb CLINICAL INDICATIONS: • Quadriceps weakness as a result of Poliomyelitis, Multiple Sclerosis, CVA, Femoral Nerve and Incomplete Spinal Cord Injuries • Genu Recurvatum. Use posterior tibial shell for maximum control • Successful users will typically have hip extensor strength (Power 3) and passive ankle dorsiflexion CONTRAINDICATIONS FOR UTX® SWING AND FS MODELS: • Any Spasticity in Hip, Knee or Ankle Musculature • Patient Weight Over 265 lbs • Passive Ankle ROM Less than 5˚ of Dorsiflexion • Valgus/Varus Instability at the Knee of More than 10˚ • Substantial Leg Length Discrepancy where the Affected Side is Shorter THERMOPLASTIC UTX® SWING AND STABIL MODELS Order No. Description 9004-S-T-80 Thermoplastic UTX® Swing 80 9004-S-T-120 Thermoplastic UTX® Swing 120 9004-STABIL-T-80 Thermoplastic UTX® Stabil 80 9004-STABIL-T-120 Thermoplastic UTX® Stabil 120 THERMOPLASTIC UTX® THERMOPLASTIC UTX® FS (FRONTAL STABILITY) AND STABIL FS MODELS Order No. Description Thermoplastic UTX® 9004-FS-T-100 Frontal Stability 100 Thermoplastic UTX® 9004-STABIL-FS-T-100 Stabil-FS 100 NOTE: Please send negative cast impression and completed UTX® orthometry forms with all necessary measurements. UTX® orthometry forms can be found on pages 2.3.9 through 2.3.10. 2.3.8 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 7 UTX® ORTHOSIS SELECTION PROTOCOL FORM This protocol needs to be applied in conjunction with the manual for UTX® orthoses Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ___________________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ When all boxes are checked, continue with STABIL 0 Function of hip extensors 1 2 3 4 0 Function of knee extensors 1 2 3 4 Wt: ______ 5 When at least one of these boxes is checked, continue with SWING 5 Hyperextension of the knee No Yes STABIL SWING Unlocks manually only, via a proximally located push button release system. Unlocks automatically with simultaneous knee extension and relative dorsiflexion. Unlocks manually via a proximally located push button release system. Knee stable in frontal plane Yes No Knee stable in frontal plane Yes No Redressed position of the knee Valgus ≤ 10˚ * Valgus > 10˚ Varus ≤ 80 kg Body Weight 80 - 120 kg > 120 kg (175 lb) (175 - 265 lb) (265 lb) UTX® -STABIL-80 * UTX®- STABIL- 120 Redressed position of the knee Valgus ≤ 10˚ * Valgus > 10˚ Varus Body Weight ≤ 100 kg > 100 kg (220 lb) (220 lb) * ≤ 80 kg Body Weight 80 - 120 kg > 120 kg (175 lb) (175 - 265 lb) (265 lb) UTX® - STABIL- FS UTX® -SWING-80 * UTX®- SWING- 120 Body Weight ≤ 100 kg > 100 kg (220 lb) (220 lb) * UTX® - SWING- FS ADDITIONAL OPTIONS YES Thermoplastic (black copoly) thigh and tibial shells for added surface contact. Anterior shells standard. Medial ankle joint to enhance M-L control of ankle instability. ADDITIONAL CONERNS Bones in the leg are capable of carrying body weight. A UTX® orthoses is not able to carry the body weight. Concerns No or small flexion contracture in the knee (less than 10 degrees). A knee flexion contracture greater than 10 degrees will load the orthosis excessively. No or minor spasticity. Spacsticity can lead to excessive forces on the orthosis. When using a UTX -SWING spasticity can result in a knee joint that will not unlock. Sufficient cognition. Cognitive problems can hamper the successful application of the SWING type. ® Take measurements and fax order: 248-588-4555 Contact Becker to discuss 248-588-7480 E-mail: [email protected] *UTX ® orthosis contraindicated. Please contact Becker Orthopedic for alternatives. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) Today’s Date: _____________________________________________ 2.3.9 3495 Sec2.3 9000 KAFO 2/19/05 3:46 PM Page 8 Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ___________________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ ANATOMICAL DATA Required with impression take measurements with leg extended * Reference line is the floor, bottom of foot, or any equivalent line perpendicular to the leg. KNEE ANGLE At large hyperextension angles (larger than 20 degrees) it is advisable to place P3 and P4 on the posterior side of the leg. Figure 1: Pelotte Carrier Locations PELOTTE CARRIER P1 LOCATION: 4 CM BELOW PERINEUM P1 PELOTTE CARRIER P2 P2 LOCATION: 6 CM ABOVE PROXIMAL EDGE OF PATELLA Knee Center Tibial Plateau 2.3.10 Today’s Date: _____________________________________________ P3 Circumferences, D1, and A-P’s required with PELOTTE CARRIER P3 impression LOCATION: 6 CM BELOW DISTAL EDGE OF PATELLA Medial Malleolus P4 PELOTTE CARRIER P4 LOCATION: 10 CM ABOVE LATERAL MALLEOLUS 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) UTX® ORTHOSIS MEASUREMENT FORM Lateral Malleolus MEDIAL ANKLE JOINT (DZ) (See Selection Form for more info) FOOTPLATE (Choose one) COLOR OF STRAPS SHOE SIZE LEFT / RIGHT BeckerOrthopedic.com Wt: ______ Knee center-reference line* Tibial plateau-reference line* Lateral malleolus-reference line* Medial malleolus-reference line* Corrected valgus or varus angle (only with UTX®-FS) Hyperextension angle Place P3 and P4 posterior Flexion contracture angle ________ cm ________ cm ________ cm ________ cm Circumference (C1) M-L Diameter (ML1) A-P Diameter (AP1) Distance (D1) - P1 to reference line* Comfortpad Circumference (C2) M-L Diameter (ML2) A-P Diameter (AP2) Distance (D2) - P2 to reference line* Comfortpad Circumference (C3) M-L Diameter (ML3) A-P Diameter (AP3) Distance (D3) - P3 to reference line* M-L from Tibial crest to lateral border Circumference (C4) M-L Diameter (ML4) A-P Diameter (AP4) Distance (D4) - P4 to reference line* Is medial ankle joint desired? M-L of ankle Preformed thermoplastic footplate Custom foot cup Mount to shoe Stainless steel footplate None, stirrup only Beige Black Navy ________________ Left Right ________ cm ________ cm ________ cm ________ cm Yes No ________ cm ________ cm ________ cm ________ cm Yes No ________ cm ________ cm ________ cm ________ cm ________ cm ________ cm ________ cm ________ cm ________ cm Yes No ________ cm Phone: Fax: ________ ˚ ________ ˚ Yes No ________ ˚ 800-521-2192 800-923-2537 3495 Sec2 Tabs 2/19/05 3:35 PM Page 7 SECTION II Central Fabrication HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES KNEE ORTHOSES (KO) BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.4.1 3495 Sec2 Tabs 2/19/05 3:35 PM Page 8 MODEL 355 PLASTIC KNEE ORTHOSIS This orthosis consists of a plastic thigh cuff and calf cuff joined together with a pair of knee joints. Any Becker knee joint may be specified to limit/control knee motion. It can be fabricated to open posteriorly or anteriorly. Please pick from the following options: • Any Becker Knee Joint. Please be sure to specify model and size • Plastic Type, Color (Natural or Black only) and Thickness • Soft liner KNEE ORTHOSES (KO) NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Order No. 355-L 355-R 355-P Description Plastic Knee Orthosis Plastic Knee Orthosis Plastic Knee Orthosis Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.4.2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2 Tabs 2/19/05 3:36 PM Page 9 ANKLE-FOOT ORTHOSES (AFO) SECTION II Central Fabrication HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.5.1 3495 Sec2 Tabs 2/19/05 3:36 PM Page 10 MODEL 270 METAL AND LEATHER AFO Model 270 is a conventional metal and leather ankle-foot orthosis. Double action, dorsiflexion assist, or standard action ankle joints may be used. Please pick from the following options: • Any Becker Ankle Joint and Stirrup. Please be sure to specify model and size. • Black, Brown, Beige, or White Leather • Hook and Loop, or Buckle Closures • Thermo-Clad™, High Buff, or Sand Blasted Finish of Uprights ANKLE-FOOT ORTHOSES (AFO) NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Order No. 270-L 270-R 270-P Description Metal and Leather AFO Metal and Leather AFO Metal and Leather AFO Side Left Right Pair MODEL 272 PHELPS CALIPER AFO The Phelps ankle-foot orthosis is a single upright orthosis that prevents plantarflexion. The upright is generally fabricated on the lateral side. Please pick from the following options: • Any Becker Phelps Caliper Plate and Upright. Please be sure to specify model and size. • Black, Brown, Beige, or White Leather • Hook and Loop, or Buckle Closures • Thermo-Clad™, High Buff, or Sand Blasted Finish of Upright NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Order No. 272-L 272-R 272-P Description Phelps Caliper AFO Phelps Caliper AFO Phelps Caliper AFO Side Left Right Pair NOTE: Please send tracing, or negative cast impression, shoes to be attached and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.5.2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 1 MODEL 333 MONODOS® AFO • Monodos® Joint, 1900-B (Adult), or 1900-C (Pediatric) • Any Becker Thermoplastic Ankle Joint for medial side • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. One-way motion only • The Monodos® AFO is not intended for weight bearing applications • For more details on our Monodos® joint, please see page 1.2.13. Order No. 333-L 333-R 333-P Description Monodos® AFO Monodos® AFO Monodos® AFO ANKLE-FOOT ORTHOSES (AFO) Model 333 is a plastic ankle-foot-orthosis designed for the management of spasticity and joint contracture, often associated with cerebral palsy, stroke and spinal cord injury. The design utilizes our model 1900-B, or 1900-C Monodos® Joint which feature a one-way clutch that allows rotation in one direction, but blocks all rotation in the opposite direction until released. The Monodos® is a cost-effective alternative to serial casting. If you are looking for a positioning orthosis, you may want to consider incorporating our Variloc® joint into your design. Please see page 4.1.22 for details. US Patent 5,328,446 Please pick from the following options: Side Left Right Pair Simple release mechanism NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.5.3 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 2 MODEL 345 TONE REDUCING AFO (TRAFO) Model 345 is a plastic tone-reducing-ankle-foot orthosis that reduces excessive tone in the foot by creating build-ups in the footplate behind the metatarsal heads. Please pick from the following options: ANKLE-FOOT ORTHOSES (AFO) • Any Becker Thermoplastic Ankle Joint • Any Becker Posterior Stop • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Order No. 345-L 345-R 345-P Description TRAFO TRAFO TRAFO Side Left Right Pair • Shown with optional ankle joints and Compcore® reinforcements. MODEL 350 CRO WALKER Model 350 is a solid ankle, clamshell design, Charcot Restrictive Orthosis. It is typically used to assist in the healing process of foot ulcers. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. Order No. 350-L 350-R 350-P Description CRO Walker CRO Walker CRO Walker Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.5.4 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 3 MODEL 370 PLASTIC AFO WITH NON ARTICULATING ANKLE Model 370 is a solid ankle, ankle-foot orthosis. It can be fabricated to create dorsiflexion assist, or provide ankle stabilization. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Description Plastic AFO with Solid Ankle Plastic AFO with Solid Ankle Plastic AFO with Solid Ankle Side Left Right Pair ANKLE-FOOT ORTHOSES (AFO) Order No. 370-L 370-R 370-P MODEL 372 SMO Model 372 is a supra malleolar orthosis. It is typically fabricated of polyethylene and is intended for use on patients with mild ankle/foot instabilities, ankle pain, or midfoot collapse. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Order No. 372-L 372-R 372-P Description SMO SMO SMO Side Left Right Pair MODEL 375 PLASTIC AFO WITH ARTICULATING ANKLE Model 375 is an ankle-foot orthosis with an articulating ankle. It can be fabricated with a variety of different ankle joint options and posterior stops to accommodate the needs of your patient. Please pick from the following options: • Any Becker Thermoplastic Ankle Joint • Any Becker Posterior Stop • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Order No. Description 375-L Plastic AFO with Articulating Ankle 375-R Plastic AFO with Articulating Ankle 375-P Plastic AFO with Articulating Ankle Side Left Right Pair • Shown with optional posterior stop, model 795 NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.5.5 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 4 AFO ORTHOMETRY FORM Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Wt: ______ ANKLE-FOOT ORTHOSES (AFO) MEASUREMENTS: Inches Centimeters Ankle Varus Valgus Flexible Rigid Degrees: __________________ Toe Out Toe In Medial Plane Lateral Plane Degrees: __________________ Heel Height: _______________ Additional Instructions: 2.5.6 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 5 AFO ORTHOMETRY FORM CONTINUED: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ LEG: Left Right Bilateral Wt: ______ MATERIAL: Thermoplastic Metal and Leather TYPE: DFA Semi-Rigid Rigid TRAFO Floor Reaction PTB Night Splint Healing Brace Bi-Value Articulating Other: ___________________________ TYPE of FO: UCB SMO Tone Reducing Insert Metal and Leather Options Plastic (select one from each column) Type Thickness Location Flares Polypropylene 1/8" Anterior Proximal Copolymer 5/32" Posterior Medial Polyethylene 3/16" Lateral 1/4" Leather (select one from each column) Color Closure T-Strap Miscellanous Black Hook & Medial Calf Lacer Beige Loop Lateral Leather Gauntlet Smoked Elk Leather None SS Footplate Brown Strap & (please provide cast) White Buckle Correct cast to: _____________________ Do not correct cast Liner (select one from each column) Type Thickness Location Aliplast 1/8" Anterior Posterior Med-Density Pelite 5/32" Footplate Heavy-Density Pelite 3/16" Plantar Surface Other ______________ 1/4" Other _________________ Ankle Joints (select type) Dorsiflexion Assist Dorsiflexion Plus Assist Slim Line Double Action Original Double Action Standard Action Size: A (Adult) Gillette Gillette Heavy Duty Gillette Dorsi Assist Camber Axis Hinge® Other __________________ ___________________________ C (Child) Posterior Stops (select type) 655 755 795 None (Free Motion) C (Child) Range of Motion Ankle Joints (select type) Tamarack Tamarack Dorsi Assist Tamarack Variable Assist™ Tamarack Clevisphere™ Oklahoma (Polypro) Oklahoma (Heavy Duty Nylon) Size: A (Adult) B (Youth) B (Youth) Stirrup (select type) Solid Solid Wide Flange Split UCBL Other __________ Other ____________________________ **Height of AFO: __________________ Plantarflexion _______________ Dorsiflexion _______________ Uprights (select one from each column) Material Stainless Steel Aluminum Finish High Buff Bead Blast Thermoclad Black White Blue Size 1/4"x 3/4" 3/16"x 3/4" 1/4"x 5/8" 3/16"x 1/2" 3/16"x 5/8" 1/8"x 1/2" Additional Instructions: ANKLE-FOOT ORTHOSES (AFO) Thermoplastic Options Miscellaneous ST Pad Dorsal Straps Loctite® all screws Figure 8 HFH Strap (Padded Dorsum Strap) Trim Lines Met. Heads: _______________________ Sulcus: ____________________________ Full Length: ________________________ Lateral Trimline BeckerOrthopedic.com Medial Trimline Phone: Fax: Length of Foot 800-521-2192 800-923-2537 2.5.7 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 6 MODELS 370 ECAD/MCAD & 375 ECAD/MCAD TRACERCAD AFOS ANKLE-FOOT ORTHOSES (AFO) TracerCAD AFOs are computer generated AFOs that utilize TracerCAD technology. This technology eliminates the use of casting materials for adult cases without significant deformity; contraindications can include tibial varum, severe pes planus, or atypical calf shape. Becker Orthopedic Engineering has created anatomically correct AFO templates to help ensure accuracy of fit and appropriate joint alignment. Existing users of TracerCAD can electronically transfer their AFO files to us for carving and fabrication. AFO files can be emailed as an attachment to [email protected] “ATTN: C-FAB CAD/CAM AFO”. 2.5.8 AFOs can also be produced from measurement by completing our comprehensive CAD/CAM AFO Orthometry Forms. This information can be faxed “ATTN: C-FAB CAD/CAM AFO” to our central fabrication department fax line at (248) 588-4555, or to our customer service department at (800) 923-2537. Same day turnaround is guaranteed for orders received by 11:00am. E.S.T. Training seminars are now being scheduled. Please contact our customer service department for more information. Please pick from the following options: • Any Becker Thermoplastic Ankle Joint • Any Becker Posterior Stop • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options SOLID ANKLE AFO BY MEASUREMENT Order No. Description 370 MCAD-L CAD Solid Ankle AFO by Measurement 370 MCAD-R CAD Solid Ankle AFO by Measurement 370 MCAD-P CAD Solid Ankle AFO by Measurement Side Left Right Pair SOLID ANKLE AFO BY ELECTRONIC FILE Order No. Description 370 ECAD-L CAD Solid Ankle AFO by Electronic File 370 ECAD-R CAD Solid Ankle AFO by Electronic File 370 ECAD-P CAD Solid Ankle AFO by Electronic File Side Left Right Pair ARTICULATING ANKLE AFO BY MEASUREMENT Order No. Description 375 MCAD-L CAD Articulating Ankle AFO by Measurement 375 MCAD-R CAD Articulating Ankle AFO by Measurement 375 MCAD-P CAD Articulating Ankle AFO by Measurement Side Left Right Pair ARTICULATING ANKLE AFO BY ELECTRONIC FILE Order No. Description 375 ECAD-L CAD Articulating Ankle AFO by Electronic File 375 ECAD-R CAD Articulating Ankle AFO by Electronic File 375 ECAD-P CAD Articulating Ankle AFO by Electronic File Side Left Right Pair BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 7 CAD/CAM AFO ORTHOMETRY FORM Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ AFFECTED SIDE: Left Right Type Lengths Measurements 1 Top of AFO 2 Mid-Calf 3 Base-Calf 4 Narrowest Calf 5 Apex of Medial Malleolus 6 Posterior Calcaneus to Apex of First Metatarsal Head 7 Posterior Calcaneus to Apex of Fifth Metatarsal Head 8 Base of Fifth Metatarsel to Apex of Fifth Metatarsal Head 9 Apex of First Metatarsel Head to Apex of Fifth Metatarsal Head 10 Navicular to Base of Fifth Metatarsal (oblique) 11 Medial Calcaneus to Lateral Calcaneus 12 Medial Malleolus to Lateral Malleolus (oblique) 13 ML at Narrowest Calf 14 ML at Base Calf 15 ML at Mid-Calf 16 ML at Top of AFO 17 AP at Heel Value SHOE SIZE: _________________ Alignment Information Ankle Mortise (If unmarked, 0˚ will be used) • Dorsiflexion _______________ • Plantarflexion ______________ Hindfoot • Inversion _______________ • Eversion _______________ Forefoot • Supination _______________ • Pronation _______________ • ADduction _______________ • ABduction _______________ Toe (If unmarked, 7˚ out will be used) ML diameters of foot • In _______________ • Out _______________ Additional Information Arch ML diameters of leg AP diameters High Mid Low None Navicular Relief Proximal Flare ( __________" standard) Custom Proximal Flare ( __________" specify depth) ANKLE-FOOT ORTHOSES (AFO) Height from bottom of foot to: MEASUREMENTS: Inches Centimeters Millimeters Wt: ______ Tibial Varum Circumference 18 at: Offset from posterior calcaneus to center of desired posteriorproximal trimline: ________________ Narrowest Calf 19 Base Calf 20 Mid-Calf 21 Top of AFO Height from floor to point where varum becomes noticeable: _______________ Additional Instructions: BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.5.9 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 8 CAD/CAM AFO ORTHOMETRY FORM CONTINUED: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ ANKLE-FOOT ORTHOSES (AFO) Wt: ______ 2.5.10 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 9 CAD/CAM AFO ORTHOMETRY FORM CONTINUED: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Plastic Thickness Polypropylene Copolymer Polyethylene 1/8" 3/16" 1/4" Wt: ______ Other: ___________ Options check the choice(s) and add any notes in “Special Instructions” Liner (select one from each column) Type Thickness Location Aliplast 1/8" Anterior Posterior Med-Density Pelite 5/32" Footplate Heavy-Density Pelite 3/16" Plantar Surface Other ______________ 1/4" Other _________________ Ankle Joints (select type) Tamarack Tamarack Dorsi Assist Tamarack Variable Assist™ Tamarack Clevisphere™ Oklahoma (Polypro) Oklahoma (Heavy Duty Nylon) Size: A (Adult) B (Youth) Posterior Stops (select type) 655 755 795 Other ____________________________ None (Free Motion) **Height of AFO: __________________ Miscellaneous ST Pad Dorsal Straps Loctite® all screws Figure 8 HFH Strap (Padded Dorsum Strap) Gillette Gillette Heavy Duty Gillette Dorsi Assist Camber Axis Hinge® Other __________________ ___________________________ C (Child) Trimlines Solid Ankle: Solid (at Malleolar Apex) Rigid (1/2" Posterior to Malleolar Apex) Posterior Leaf Spring (Dorsiflexion Assist) Footplate: Full Sulcus (Draw trimlines as necessary) Other: _______________________________ ANKLE-FOOT ORTHOSES (AFO) Other: __________________________________________________ Special Instructions: Shipping Instructions UPS Next Day Air UPS Ground BeckerOrthopedic.com UPS 2nd Day Air UPS 3 Day Select Phone: Fax: Other: _________________________ 800-521-2192 800-923-2537 2.5.11 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 10 MODEL 340 FLOOR REACTION AFO Model 340 is a solid ankle, ankle-foot orthosis. The solid ankle configuration sets the limits of plantar and dorsiflexion and controls subtalar motion. The anterior panel helps control weak quadriceps and resulting knee flexion. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options ANKLE-FOOT ORTHOSES (AFO) Order No. 340-L 340-R 340-P Description Floor Reaction AFO Floor Reaction AFO Floor Reaction AFO Side Left Right Pair MODEL 360 PTB ORTHOSIS Model 360 is a patellar-tendon-bearing orthosis with a posterior shell and an overlapping anterior shell, held in place with hook and loop straps. Carbon fiber inserts (shown) can also be embedded into the ankle complex to resist dorsi or plantarflexion. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options PTB Orthosis with Non Articulating Ankle Order No. Description 360-L PTB Orthosis with Non Articulating Ankle 360-R PTB Orthosis with Non Articulating Ankle 360-P PTB Orthosis with Non Articulating Ankle • Shown with optional Compcore Ankleform® reinforcements Side Left Right Pair PTB Orthosis with Articulating Ankle and Growth Adjustments Order No. Description Side PTB Orthosis with Articulating Ankle 363-L Left and Growth Adjustments PTB Orthosis with Articulating Ankle 363-R Right and Growth Adjustments PTB Orthosis with Articulating Ankle 363-P Pair and Growth Adjustments MODEL 378 CLAMSHELL AFO Model 378 is an ankle-foot orthosis with an anterior panel, held in place with hook and loop straps. Model 378 is biomechanically similar to the floor reaction AFO, except a full anterior panel has been added to help control weak quadriceps and resulting knee flexion. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Order No. 378-L 378-R 378-P Description Clamshell AFO Clamshell AFO Clamshell AFO Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.5.12 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 11 MODEL 379 PLASTIC & METAL AFO Model 379 is a plastic and metal ankle-foot orthosis that consists of a plastic calf section, metal ankle joints and a UCBL footplate. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness • Any Becker Ankle Joint and UCBL stirrup insert NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Description Plastic and Metal AFO Plastic and Metal AFO Plastic and Metal AFO ANKLE-FOOT ORTHOSES (AFO) Order No. 379-L 379-R 379-P Side Left Right Pair MODEL 395 PROGRESSIVE AFO™ Model 395 is a hybrid ankle-foot orthosis with adjustable metal ankle joints that uses ground reaction forces to control ankle, foot and knee instability in individuals with neuromuscular involvement. Please pick from the following options: • Small, medium, or large Camber Axis Hinges® • Thickness (0.06" or 0.09") of Carbon Fiber reinforcement (Compcore®) • Plastic type, color (Natural or Black only) and thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options FEATURES: • Hybrid Design that Combines the Positive Aspects of Thermoplastic, Carbon Fiber Reinforcement and Metal Adjustable Ankle Joints • Cost Effective, Definitive Orthosis with Inherent Adjustability, designed to Compliment Physical Therapy • The Camber Axis Hinge® provides variable range of motion or fixed ankle positioning. Order No. 395-L 395-R 395-P Description Progressive AFO Progressive AFO Progressive AFO Side Left Right Pair Camber Axis Hinge® US Patent 5,542,774 • Camber Axis Hinge® Information CD available for self-study and PCE credits. Please call our customer service department for details. NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.5.13 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 12 MODEL 396 XAFO Model 396 is a low profile ankle-foot orthosis designed to provide effective M-L control of the foot ankle complex. The XAFO utilizes stainless steel Camber Axis Hinges® for added strength and variable motion control. The XAFO may also be ordered as a kit. Please see page 1.5.5 for details. Camber Axis Hinge® US Patent 5,542,774 ANKLE-FOOT ORTHOSES (AFO) • Camber Axis Hinge® Information CD available for self-study and PCE credits. Please contact our customer service department for details. FEATURES: • Camber Axis Hinges® • Prefabricated Thermoplastic Medial and Lateral Uprights • Interface Padding • Proximal and Distal Straps Order No. 396-L 396-R 396-P Description Custom XAFO Custom XAFO Custom XAFO Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. 2.5.14 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 13 AFO ORTHOMETRY FORM Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ Wt: ______ MEASUREMENTS: Inches Centimeters Varus Valgus Flexible Rigid Degrees: __________________ Toe Out Toe In Medial Plane Lateral Plane Degrees: __________________ ANKLE-FOOT ORTHOSES (AFO) Ankle Heel Height: _______________ Additional Instructions: BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.5.15 3495 Sec2.5 AFO 2/19/05 3:44 PM Page 14 AFO ORTHOMETRY FORM CONTINUED: Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ LEG: Left Right Bilateral Wt: ______ MATERIAL: Thermoplastic Metal and Leather TYPE: DFA Semi-Rigid Rigid TRAFO Floor Reaction PTB Night Splint Healing Brace Bi-Value ANKLE-FOOT ORTHOSES (AFO) Articulating Other: ___________________________ TYPE of FO: UCB SMO Tone Reducing Insert Thermoplastic Options Metal and Leather Options Plastic (select one from each column) Type Thickness Location Flares Polypropylene 1/8" Anterior Proximal Copolymer 5/32" Posterior Medial Polyethylene 3/16" Lateral 1/4" Leather (select one from each column) Color Closure T-Strap Miscellanous Black Hook & Medial Calf Lacer Beige Loop Lateral Leather Gauntlet Smoked Elk Leather None SS Footplate Brown Strap & (please provide cast) White Buckle Correct cast to: _____________________ Do not correct cast Liner (select one from each column) Type Thickness Location Aliplast 1/8" Anterior Posterior Med-Density Pelite 5/32" Footplate Heavy-Density Pelite 3/16" Plantar Surface Other ______________ 1/4" Other _________________ Ankle Joints (select type) Dorsiflexion Assist Dorsiflexion Plus Assist Slim Line Double Action Original Double Action Standard Action Size: A (Adult) Gillette Gillette Heavy Duty Gillette Dorsi Assist Camber Axis Hinge® Other __________________ ___________________________ C (Child) Posterior Stops (select type) 655 755 795 None (Free Motion) C (Child) Range of Motion Ankle Joints (select type) Tamarack Tamarack Dorsi Assist Tamarack Variable Assist™ Tamarack Clevisphere™ Oklahoma (Polypro) Oklahoma (Heavy Duty Nylon) Size: A (Adult) B (Youth) B (Youth) Stirrup (select type) Solid Solid Wide Flange Split UCBL Other __________ Other ____________________________ **Height of AFO: __________________ Plantarflexion _______________ Dorsiflexion _______________ Uprights (select one from each column) Material Stainless Steel Aluminum Finish High Buff Bead Blast Thermoclad Black White Blue Size 1/4"x 3/4" 3/16"x 3/4" 1/4"x 5/8" 3/16"x 1/2" 3/16"x 5/8" 1/8"x 1/2" Additional Instructions: Miscellaneous ST Pad Dorsal Straps Loctite® all screws Figure 8 HFH Strap (Padded Dorsum Strap) Trim Lines Met. Heads: _______________________ Sulcus: ____________________________ Full Length: ________________________ Lateral Trimline 2.5.16 BeckerOrthopedic.com Medial Trimline Phone: Fax: Length of Foot 800-521-2192 800-923-2537 3495 Sec2 Tabs 2/19/05 3:36 PM Page 11 SECTION II CENTRAL FABRICATION ADD-ONS Central Fabrication HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.6.1 3495 Sec2 Tabs 2/19/05 3:36 PM Page 12 PELVIC BANDS Order No. D-1 D-2 Description Unilateral Pelvic Band (please specify Right or Left and Hip Joints when ordering) Bilateral Pelvic Band (please specify joints when ordering) CENTRAL FABRICATION ADD-ONS ISCHIAL SEATS & RINGS Order No. D-3 D-4 Description Ischial Ring (shown) Ischial Seat GROWTH ADJUSTMENTS Order No. D-5 D-6 Description Loop Type Growth Adjustment (please specify AK or BK) Lap Type Growth Adjustment (please specify AK or BK) (shown) RING LOCK ASSISTS Order No. D-7 D-8 Description Ball Catch (shown) Spring Pull KNEE PADS Order No. D-9 D-10 D-11 Description 5-Buckle Knee Pad - Please specify size (pediatric, small, medium, or large) and leather color 4-Buckle Knee Pad (shown) - Please specify size (pediatric, small, medium, or large) and leather color 3-Buckle Knee Pad - Please specify size (pediatric, small, medium, or large) and leather color NOTE: Custom knee pads are available upon request. Please specify size, leather color and number of buckles when ordering. Hook and loop closures are also available. 2.6.2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.6 AddOns 2/19/05 3:43 PM Page 1 MOLDED LEATHER Order No. D-12 D-13 D-18 D-18W Description Molded Leather Thigh Lacer Molded Leather Calf Lacer Molded Leather Boot (shown) Molded Leather Wrist Gauntlet Note: Please send negative cast impression and completed orthometry form with all necessary measurements. CONDYLE PADS Order No. D-15 FOOTPLATES Order No. D-16 D-19 Description UCBL With Stirrup Inserts Stainless Steel Footplate (shown) - (negative cast required) T-STRAP Order No. D-21 D-21P Description T-Strap - Please specify size (small, medium, or large), leg and medial or lateral Padded T-Strap - Please specify size (small, medium, or large), leg and medial or lateral Note: Custom T-Straps are available upon request. Please specify size, leather color, leg and side. Hook and loop closures are also available. SHOE MODIFICATIONS Order No. D-17 D-54 D-54C D-55 D-56 D-56M D-56MR D-57 D-57M D-58 D-58M D-59 D-59M D-61 D-61M BeckerOrthopedic.com CENTRAL FABRICATION ADD-ONS D-14 Description Round Condyle Pad (shown) for Free Motion or Lever Lock Joints (please specify size) Pear Shape Condyle Pad for Ring Lock Joints (please specify right, left, medial, or lateral) Description Perthese Rocker (shown) Posting Crepe Posting Carlson Modification Build-Up on Non-Molded Shoe Up to 1" Build-Up on Molded Shoe Up to 1" Rocker Sole Build-Up to 1" Sole and Heel Wedge on Non-Molded Shoe Sole and Heel Wedge on Molded Shoe Heel Wedge on Non-Molded Shoe Heel Wedge on Molded Shoe Sole Wedge on Non-Molded Shoe Sole Wedge on Molded Shoe Heel Lift on Non-Molded Shoe Up to 1" Heel Lift on Molded Shoe Up to 1" Phone: Fax: 800-521-2192 800-923-2537 2.6.3 3495 Sec2.6 AddOns 2/19/05 3:43 PM Page 2 REINFORCEMENTS Order No. D-18A D-26 D-26A Description Aluminum Band Reinforcement Compcore Ankleform® Reinforcement Compcore® Band or Corrugate Reinforcement CENTRAL FABRICATION ADD-ONS SOFT INTERFACES Order No. D-27 D-27A D-28 D-28A D-29 Description Soft Interface Lining Thigh Fully Lined KAFO Soft Interface Lining Calf Fully Lined AFO Soft Interface Lining Foot VENTILATION HOLES Order No. D-33 Description Ventilation Holes RELIEFS Order No. D-34 D-35 Description Flares Cut-Outs QUADRILATERAL BRIM Order No. D-30 Description Quadrilateral Brim ANTERIOR PANELS Order No. D-31 D-32 2.6.4 BeckerOrthopedic.com Description Anterior Femoral Panel Anterior Tibial Panel Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.6 AddOns 2/19/05 3:43 PM Page 3 THERMOPLASTIC ANKLE COMPONENTS Order No. D-22 D-22A D-22B D-23 D-24 D-24A D-43 D-44 D-45 Description Gillette Ankle Joints Tamarack Flexure JointsTM Tamarack Dorsi Assist Flexure JointsTM Oklahoma Ankle Joints Scotty Ankle Joints Scotty Econoline Ankle Joints Camber Axis Hinge® Plastic Overlap Joints Kid-Dee-LiteTM Ankle Joints Order No. D-25 D-38 D-39 CENTRAL FABRICATION ADD-ONS MOTION CONTROL LIMITERS Description 795 Motion Control Limiter 655 Motion Control Limiter 755 Motion Control Limiter Note: Please see page 5.5.12 for more information on our Motion Control Limiters. TRANSFER PAPER Order No. D-109 D-110 Description Transfer Paper - AFO Transfer Paper - KAFO Note: Please contact our central fabrication department for a list of available images. LEVER RELEASE SYSTEMS Order No. D-52 D-52HD Description Lever Release System Heavy Duty Lever Release System BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.6.5 3495 Sec2 Tabs 2/19/05 3:36 PM Page 13 SECTION II Central Fabrication BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 CRANIAL /UPPER EXTREMITY ORTHOSES HIP-KNEE-ANKLE-FOOT ORTHOSES (HKAFO) KNEE-ANKLE-FOOT ORTHOSES (KAFO) 9000 SERIES KNEE-ANKLE-FOOT ORTHOSES (9000 KAFO) KNEE ORTHOSES (KO) ANKLE-FOOT ORTHOSES (AFO) CENTRAL FABRICATION ADD-ONS CRANIAL/UPPER EXTREMITY ORTHOSES 2.7.1 3495 Sec2 Tabs 2/19/05 3:36 PM Page 14 MODEL 310 CRANIAL REMOLDING ORTHOSIS CRANIAL /UPPER EXTREMITY ORTHOSES Model 310 is designed to apply pressure to prominent regions of an infant’s cranium to improve cranial symmetry and shape. The Cranial Remolding Orthosis can be manufactured from a positive, or negative impression of the infant’s head. Intended for infants 3 to 18 months of age with moderate to severe non-synostotic positional plagiocephaly, including plagiocephalic, brachycephalic, scaphocephalic shaped heads. In accordance with FDA guidelines this device is available to qualified and licensed practitioners. Training seminars are now being scheduled. Please contact our customer service department for more information. Please pick from the following options: • Plastic Type, Color (Natural or Black only) and Thickness • Choice of Transfer Paper. Please contact our central fabrication department for a list of available images. Order No. 310 310-A Description Cranial Remolding Orthosis Cranial Remolding Orthosis with Anterior Opening NOTE: Please send positive or negative cast impression and completed Cranial Remoldeling Orthosis form with all necessary measurements. 2.7.2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 Cranial Remolding Orthosis Order Form Note: A completed order form is required before the order can be processed. ORTHOTIST INFORMATION Shipping Address: __________________________ P.O. #: ______________________________________ ______________________________________ Date Requested: ______________________________ ______________________________________ Phone: ______________________________________ City: ________________ State: ___ Zip: ______ Fax: _______________________________________ • • Turnaround time is 4 business days from receipt of scan and completed order form. For best results, the patient should be fit within two weeks from the date of the scan/cast. PATIENT INFORMATION Patient Name: ______________________Date of Birth: ___________Date of Scan/Cast: ______________ Diagnosis: Plagiocephaly Brachycephaly Other______________________ SCAN/CAST INFORMATION Required Landmarks: Outline of ears, brow line marked on both temples, center of nose marked on forehead Scan Impression: Unmodified Scan/Cast Modified Scan/Cast Description of Cranial Form (please indicate all applicable conditions): FLATTENING Left Bilateral Right N/A Occipital Area Parietal Area Ear – Anterior Shift Frontal Bossing Elevated Cranial Height DESCRIPTION OF DEFORMITY Left Right Posterior N/A CRANIAL /UPPER EXTREMITY ORTHOSES Facility Name: ____________________________ Orthotist Name: ______________________________ Please completely fill out the order form including all required measurements and information. Page 1 of 2 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.7.3 CRANIAL /UPPER EXTREMITY ORTHOSES REQUIRED MEASUREMENTS Take measurements at a level just above the top of the ears and the brow line over stockinette. Order will not be processed without required measurements. FOR INTERNAL USE ONLY ORTHOTIST UNMODIFIED MOLD MODIFIED MOLD Circumference: _____cm Circumference: _____cm Circumference: _____cm Cranial Length: _____cm Cranial Length: _____cm Cranial Length: _____cm Cranial Width: _____ cm Cranial Width: _____cm Cranial Width: _____cm Build-up added Right Anterior Left Anterior Right Posterior Left Posterior ORTHOSIS INFORMATION Side Opening: Left Right Attach Chafe: Anterior to slot Posterior to slot Send – do not attach Transfer Paper Design: ________________________________ Positive Image Transfer: ________________________________ Liner Thickness & Density Copolymer Shell ¼ Medium ¼ Soft ½ Medium ½ Soft SPECIAL INSTRUCTIONS ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ SHIPPING INSTRUCTIONS UPS Ground UPS 2ND Day Air UPS Next Day Air Other: _____________________ FOR INTERNAL USE Order Number: _________________________ Approved By: ______________________ Please completely fill out the order form including all required measurements and information. Page 2 of 2 REV 03/11 2.7.3A BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 CRANIAL /UPPER EXTREMITY ORTHOSES REQUIRED MEASUREMENTS Take measurements at a level just above the top of the ears and the brow line over stockinette. Order will not be processed without required measurements. FOR INTERNAL USE ONLY ORTHOTIST UNMODIFIED MOLD MODIFIED MOLD Circumference: _____cm Circumference: _____cm Circumference: _____cm Cranial Length: _____cm Cranial Length: _____cm Cranial Length: _____cm Cranial Width: _____ cm Cranial Width: _____cm Cranial Width: _____cm Build-up added Right Anterior Left Anterior Right Posterior Left Posterior ORTHOSIS INFORMATION Side Opening: Left Right Attach Chafe: Anterior to slot Posterior to slot Send – do not attach Transfer Paper Design: ________________________________ Positive Image Transfer: ________________________________ Liner Thickness & Density Copolymer Shell ¼ Medium ¼ Soft ½ Medium ½ Soft SPECIAL INSTRUCTIONS ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ SHIPPING INSTRUCTIONS UPS Ground UPS 2ND Day Air UPS Next Day Air Other: _____________________ FOR INTERNAL USE Order Number: _________________________ Approved By: ______________________ Please completely fill out the order form including all required measurements and information. Page 2 of 2 REV 03/11 2.7.3A BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.7 UpperExtrem 2/19/05 3:41 PM Page 2 MODEL 331 MONODOS® CUSTOM ELBOW ORTHOSIS CRANIAL /UPPER EXTREMITY ORTHOSES Model 331 is a plastic elbow orthosis designed for the management of spasticity and joint contracture, often associated with cerebral palsy, stroke and spinal cord injury. US Patent 5,328,446 Please pick from the following options: • Monodos® Joint, 1900-B (Adult), or 1900-C (Pediatric) • Any Becker Joint for Medial side • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. One-way motion only • The Monodos® is a cost-effective alternative to serial casting • For details on our Monodos® joint, please see page 1.2.13. Simple release mechanism Order No. 331-L 331-R 331-P Description Monodos® Elbow Orthosis Monodos® Elbow Orthosis Monodos® Elbow Orthosis Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.7.4 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.7 UpperExtrem 2/19/05 3:41 PM Page 3 MODEL 336 VARILOC® ELBOW ORTHOSIS • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options. 260° 10° STOPS 130° • For details on our Variloc® joint, please see page 4.1.22. Order No. 336-L 336-R 336-P Description Variloc® Elbow Orthosis Variloc® Elbow Orthosis Variloc® Elbow Orthosis Side Left Right Pair CRANIAL /UPPER EXTREMITY ORTHOSES Model 336 is a plastic elbow orthosis that allows for adjustable positioning of the elbow in 10˚ increments. The Variloc® Positioning Joint is positively engaged by high strength locking pins, which can be instantly disengaged by a pushbutton mechanism, allowing the joint to flex or extend. Note:The Variloc® cannot be used as a free motion joint. US Patent 5,689,999 Please pick from the following options: NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.7.5 MODEL 337 RATCHET LOCK™ ELBOW ORTHOSIS CRANIAL /UPPER EXTREMITY ORTHOSES Model 337 is a plastic elbow orthosis designed to promote full arm extension by providing 7 different locking positions in 14˚ increments. The Ratchet LockTM joint features a secure, semi-automatic locking mechanism that can be quickly and easily disengaged. Please pick from the following options: • Ratchet Lock™ Joint Size and Upright Material • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Distinctive, low profile locking mechanism. • For details on our Ratchet Lock™ joint, please see page 4.1.18. Order No. 337-L 337-R 337-P Variable flexion knee lock has 8 different locking positions in 12° increments. Description Ratchet LockTM Elbow Orthosis Ratchet LockTM Elbow Orthosis Ratchet LockTM Elbow Orthosis Side Left Right Pair NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. 2.7.6 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.7 UpperExtrem 2/19/05 3:41 PM Page 5 MODEL 334 MONODOS® WRIST ORTHOSIS Model 334 is a plastic wrist orthosis designed for the management of spasticity and joint contracture, often associated with cerebral palsy, stroke and spinal cord injury. The design utilizes our model 1900-B, or 1900-C Monodos® Joint which features a one-way clutch that allows rotation in one direction, but blocks all rotation in the opposite direction until released. The Monodos® is a cost-effective alternative to serial casting. US Patent 5,328,446 CRANIAL /UPPER EXTREMITY ORTHOSES • For details on our Monodos® Joint, please see page 1.2.13. Please pick from the following options: • Monodos® Joint, 1900-B (Adult), or 1900-C (Pediatric) • Any Becker Joint for medial side • Plastic Type, Color (Natural or Black only) and Thickness NOTE: Please see pages 2.6.2 through 2.6.5 for additional options Order No. 334-L 334-R 334-P Description Monodos® Wrist Orthosis Monodos® Wrist Orthosis Monodos® Wrist Orthosis Side Left Right Pair One-way motion only Simple release mechanism NOTE: Please send negative cast impression and completed orthometry form with all necessary measurements. Other manufacturers components may also be specified, however these options will include additional charges. BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537 2.7.7 3495 Sec2.7 UpperExtrem 2/19/05 3:41 PM Page 6 RANCHO WRIST HAND ORTHOSES These orthoses were originally developed at Rancho Los Amigos Hospital in California. MODEL U-16C CUSTOM STATIC WRIST HAND ORTHOSIS CRANIAL /UPPER EXTREMITY ORTHOSES Model U-16C is a lightweight, padded, aluminum and leather positioning orthosis. 2.7.8 Note: Please provide cast with wrist in 30-35˚ of extension (measured from the second metacarpal to the radius). Position the thumb in abduction, extend the IP joint and rotate the thumb so it touches the finger pads. Please also provide completed orthometry form, on page 2.7.10, with order. Order No. U-16CL U-16CR BeckerOrthopedic.com Description Custom Static WHO Custom Static WHO Size Left Right Phone: Fax: 800-521-2192 800-923-2537 3495 Sec2.7 UpperExtrem 2/19/05 3:41 PM Page 7 MODEL U-17C CUSTOM WRIST DRIVEN WRIST HAND ORTHOSIS CRANIAL /UPPER EXTREMITY ORTHOSES Model U-17 utilizes wrist extensor power to provide a pinch mechanism for the paralytic hand. Indicated for patients demonstrating fair wrist extensors, this orthosis is excellent for adding eating or writing utensils. Note: Please provide cast with wrist in 30-35˚ of extension (measured from the second metacarpal to the radius). Position the thumb in abduction, extend the IP joint and rotate the thumb so it touches the finger pads. Please also provide completed orthometry form, on page 2.7.10, with order. Order No. Description Size U-17CL Custom Wrist Driven WHO Left U-17CR Custom Wrist Driven WHO Right MODEL U-18C CUSTOM RATCHET WRIST HAND ORTHOSIS Model U-18 provides a pinch mechanism for the paralytic hand by utilizing a ratchet. It is for patients demonstrating less than fair wrist extensors. This orthosis is also excellent for adding eating or writing utensils. Note: Please provide cast with wrist in 30-35˚ of extension (measured from the second metacarpal to the radius). Position the thumb in abduction, extend the IP joint and rotate the thumb so it touches the finger pads. Please also provide completed orthometry form, on page 2.7.10, with order. Order No. U-18CL U-18CR Description Custom Rachet WHO Custom Rachet WHO BeckerOrthopedic.com Size Left Right Phone: Fax: 800-521-2192 800-923-2537 2.7.9 3495 Sec2.7 UpperExtrem 2/19/05 3:41 PM Page 8 CRANIAL /UPPER EXTREMITY ORTHOSES WHO ORTHOMETRY FORM Today’s Date: _____________________________________________ Patient: ___________________________________________________ Facility: ___________________________________________________ Age: ______ Sex: ______ Ht: ______ Street: ____________________________________________________ Diagnosis: ________________________________________________ City: _____________________________ State: _____ Zip:_________ ______________________________________________________ Orthotist: _________________________________________________ Delivery Date: _____________________________________________ Phone Number: ___________________________________________ PO Number: ______________________________________________ MODEL: U-16 U-17 U-18 SIDE: Left Right Wt: ______ Additional Instructions: 2.7.10 BeckerOrthopedic.com Phone: Fax: 800-521-2192 800-923-2537